Management

• General measures including fluid resuscitation, maintaining Hb at 7-10g/dl, respiratory support, analgesia, and anti-emetics. Routine antibiotic therapy is of unproved benefit.

• Adequate monitoring should be instituted, including cardiac output monitoring if cardiorespiratory instability is present.

• The patient is conventionally kept nil by mouth with continuous NG drainage, and nutrition and vitamins provided IV. However, recent studies show safety and efficacy of distal nasojejunal — and even nasogastric—enteral feeding.

• Gallstone obstruction should be relieved either endoscopically or surgically.

• Hypocalcaemia, if symptomatic, should be treated by intermittent slow IV injection (or, occasionally, infusion) of 10% calcium chloride.

• Hyperglycaemia should be controlled by a continuous insulin infusion.

• No specific treatment is routinely used.

• The role and extent of surgery remains controversial; Some advocate percutaneous drainage of infected and/or necrotic debris while surgery frequently consists of regular (often daily) laparotomy with debridement of necrotic tissue and peritoneal lavage. Pseudocysts may resolve or require drainage either percutaneously or into the bowel.

P.355

0 0

Post a comment